Wyomingites pays more for health insurance than residents of any other state. And thanks to Obamacare, we’re about to pay a lot more. Starting in 2018, employer-based health plans that exceed $10,200 in premiums for individuals and $27,500 for families will be hit with a whopping 40 percent “Cadillac Tax.” If you receive health insurance through your work, get ready to pay a lot more for it. And even if you don’t, be prepared for higher taxes.

The issue was raised at the Joint Labor, Health, and Social Services Committee meeting held in Lovell, WY in late August. Wyoming’s Insurance Commissioner Tom Glause, said virtually every employer that offers health insurance in the state will be hit by this tax. Upon hearing this, Representative Lloyd Larsen responded:

“I want to make sure that I’m understanding right. The ACA, as it was passed, is intended to help provide insurance for all citizens of the United States. So, now, if you’ve got an employer that is providing an exceptional insurance plan, they will be taxed for providing insurance to citizens of the United States. Is that correct?”

Sadly Representative Larson is correct. After raising insurance premiums through thousands of pages in regulations, Obamacare will now punish workers, businesses, and taxpayers for paying high premiums.

The healthcare law mandates that health plans cover a range of expensive services. As these rules took effect, Wyoming’s insurance premiums increased a whopping 195 percent in 2014, according HealthPocket.com. Next year, premiums are expected to rise by another 38 percent. As Obamacare continues to raise the cost of insurance, it will force more families and individuals to pay the Cadillac Tax.

Obamacare’s architects sold this tax by claiming it will encourage employers to offer less expensive health plans to their workers. However, Obamacare’s countless insurance mandates make it impossible for employers to offer low-cost insurance. Instead, businesses will reduce premiums by shifting their plans’ costs onto their employees by raising deductibles and copays.

Eventually, businesses won’t be able to keep shifting costs onto employees—Obamacare forbids employers from foisting more than 40% of a plan’s costs onto their workers. So businesses have a choice to make; they can either pay the penalty or reduce their employees’ healthcare coverage. For an employee, this means fewer doctor and benefit choices.

But what if you bought your insurance on the individual market? Although your health plan won’t be hit by the Cadillac Tax, you’ll still pay it through higher state and local taxes. Public sector workers enjoy some of the most generous health plans in the country and they’ll be hit hard by this tax. Those costs will be passed onto you.

According to Ralph Hayes, manager of the Wyoming State Group Insurance Program, the Cadillac Tax will hike state health plans by $4.3 million in the first year alone. But it gets worse. Wyoming’s cities and counties employ another 47,000 workers who have health benefits that are just as generous as state workers. According to WyLiberty’s calculations, the Cadillac Tax will likely penalize Wyoming taxpayers an additional $20.7 million for these plans. As the premiums on these health plans continue to rise, our tax burden will rise as well.

Obamacare was sold to the public by promising to make healthcare more affordable. But after hearing these numbers, it was clear to everyone at the meeting that the Cadillac Tax was designed solely to gouge patients and taxpayers. As Mr. Hayes put it, “This Cadillac tax really was aimed at a revenue-generating device to pay for the [Obamacare] individual market subsidies, and it is going to accomplish that.”

For most of us, our healthcare is paid for by someone else; either our employer or a government entitlement program.  When someone else is paying, why bother shopping around for the best price?  Now an innovative new company has found a way to make patients cost-conscious and lower prices.

Since World War II, employer-sponsored insurance has remained an untaxed benefit.  Companies began offering health insurance to attract workers after the Roosevelt Administration imposed wage freezes.   These benefits became so popular that large employers successfully lobbied the IRS to exempt health coverage from taxation in 1943.  This allowed businesses to compensate workers through untaxed benefits.  And workers enjoy untaxed compensation in the form of health insurance.

Unfortunately, employer-sponsored insurance has led to exploding costs in our healthcare system.  Workers have zero incentive to shop for discounts when their employers are paying the tab.   Government magnified these distorting incentives by paying for the healthcare of low-income people through Medicaid and the elderly through Medicare.

However, one company has forged a path to affordable healthcare; paying patients to find lower prices.  Vitals SmartShopper is a company based in Bedford, New Hampshire that allows patients to comparison shop online for medical services.  When patients find a lower price than the one offered by their doctor, they’re cut a check through the savings they generate for their insurer or employer.  Just last year, 16,000 SmartShopper patients earned $1.3 million for saving their insurers $11 million on medical services.

Wyoming is in dire need of SmartShopper’s savings. According to Wyoming’s Hospital Association, the average price for a hip replacement here is over $53,000.  But doctors in Colorado perform them for as little as $21,000.  There is no reason why Wyoming patients shouldn’t demand the same prices from their local hospitals.  And they’ll be paid thousands for doing so.

This payment model could also save taxpayers money.  Wyoming pays more for public employee health benefits than any other state, about $25,000 per worker for family coverage. And when Obamacare’s Cadillac Tax hits in 2018, we’ll be paying even more.

State employees in Kentucky and New Hampshire are already delivering better value to taxpayers by using SmartShopper.  State health plans on average save $500 on CT Scans and $780 on MRIs when their workers hunt for discounts.  According to a SmartShopper spokesman:

“Providers have learned about what we’re doing, and are looking to lower their costs to stay competitive.”

Paying patients to shop for lower prices could even be applied to Medicaid.  Like individuals with traditional insurance, Medicaid enrollees have no reason to shop for lower cost procedures when only the government enjoys in the savings.  But paying Medicaid’s low income recipients to find discounts won’t just save taxpayers money; it will also provide them additional cash assistance.

Every year patients order trillions of dollars of tests and procedures and are completely indifferent to their costs.  Now SmartShopper and other entrepreneurs have discovered that patients will actively seek lower prices if the savings are passed on to them.  These are innovations Wyoming cannot afford to ignore.

No single provision of Obamacare has been more disastrous than Medicaid Expansion.  It’s cost taxpayers billions more than promised and hurt the very people it was intended to help.  Now Governor Mead wants to try yet again to expand this ruinous government program in Wyoming.

Following an event at an oil recovery facility in Riverton, Mead commented:

“I think it’s appropriate for members of [the Joint Appropriations Committee] and the Legislature, as a whole, to take a look at [Medicaid Expansion] and see if we want to again forgo that money during these tough budget times.”

The Governor could not be more wrong.

For starters, Medicaid Expansion won’t save Wyoming money; it only creates new expensive promises.  For Wyoming to receive Medicaid Expansion dollars, we would have to open the program to individuals making up to $16,000 every year and families making $30,000.  The government estimates that 17,000 new individuals will enroll.

However, just about every state has wildly underestimated how many people will actually sign-up.  The Foundation for Government Accountability analyzed enrollment numbers of 17 states that expanded Medicaid and found that nearly twice as many people registered than government analysts predicted.  In the case of Colorado, three times as many people enrolled than expected.  If Wyoming’s estimates are as off as Colorado’s, taxpayers would be on the hook for 52,000 new Medicaid patients.

Medicaid’s exploding enrollment numbers also mean exploding costs.  Kentucky signed up 221,000 more individuals than anticipated. Now their Medicaid program is projected to be $1.5 billion over budget.  Illinois initially projected 342,000 new individuals signing up through Medicaid Expansion.  By April over 633,671 had enrolled and will cost $2 billion more.

What’s even more absurd is that Governor Mead wants to expand Medicaid when Wyoming faces a severe budget crisis.  Wyoming relies heavily on tax revenue from the minerals industry to finance government programs.  Over the last several years, the price of minerals fell precipitously.  As a result, Wyoming’s Consensus Revenue Estimating Group (CREG) estimates in its January revenue forecast that mineral tax revenue will fall by $250 million over the 2015-2016 Biennium.  Wyoming simply does not have the resources to expand Medicaid when it cannot even finance its current obligations.

At a time when Wyoming faces severe belt tightening, can Governor Mead in good faith promise healthcare to tens of thousands of new beneficiaries?  In a word: No.  According to the Kaiser Family Foundation, Wyoming’s Medicaid program reimburses doctors 76 percent above the national average. This largess is no doubt thanks to the severance tax bonanza. Those days are over.  If Mead successfully expands Medicaid, the program will likely cut its payments to doctors because it won’t have the funds it had when mineral revenue was pouring in.

Hospitals in expansion states are already buckling under Medicaid’s mounting costs.  Because the program pays doctors so little, Michael Kasser of Southern Illinois Healthcare reported that his hospital group lost $14 million treating Medicaid’s new patients.  As Medicaid foists ever mounting losses on providers, patients will be deprived of the very care the program was meant to provide.

Medicaid has demonstrated time and again that it is a disaster for patients and a fiscal nightmare for taxpayers.  Rather than trying to expand a broken program, the government must get out of the way of doctors, hospitals and private charities and allow them to aid society’s most vulnerable.

With just a few weeks until open enrollment, WINhealth has decided to leave Wyoming’s health insurance exchange. The insurer hoped that Obamacare’s federal bailout fund would pay for its losses. However, it only paid insurers a fraction of what it promised. Wyoming legislators rejected Medicaid expansion last year because they worried the federal government would renege on its promises and here is a prime example. Insurers have found out the hard way the federal government can’t be trusted. Let’s hope it is a lesson learned by legislators still pushing for Medicaid expansion.

Obamacare foists enormous costs on insurers. For starters, they must offer insurance to anyone who wants it, regardless of health status. Insurers must also cover a range of expensive Essential Health Benefits. These include maternity care, pediatric service, and prescription drugs.

To help pay for the costly mandates, Obamacare established a slush fund, or Risk Corridor, to bailout struggling insurers. Carriers with larger than expected earnings have to contribute half of their profits to this account to compensate those that earned significantly less than expected. Like all government spending schemes, the federal government claimed it would make money for taxpayers. The Congressional Budget Office estimated this fund would generate $8 billion in savings to taxpayers over three years.

But not many insurers are profitable under Obamacare. Out of $2.87 billion in aid insurers requested, the fund could only pay out $362 million, according to the Center for Medicare Services. Without this bailout fund’s support, insurers now face millions in losses, and some have stopped selling insurance for good.

The insurer WINhealth was hit particularly hard by this broken promise and has decided to leave Wyoming’s insurance exchange. The company expected a $5 million payout but received a mere $600,000. Stephen Goldstone, the company’ president and chief executive officer, laid the blame squarely on Obamacare’s broken promises:

“The federal government’s decision to significantly reduce the reimbursement we would receive under the risk corridor program came as a complete surprise to WINhealth, This, combined with the continuous delays in repayment, has caught WINhealth flat-footed with no choice but to turn down participating in the exchange for 2016.”

With WINhealth gone, Blue Cross Blue Shield is the sole insurer on Wyoming’s exchange. BCBS is now free to raise premiums knowing patients have nowhere else to turn to for insurance. They will also undoubtedly increase premiums now that they know the federal Risk Corridor program cannot be relied upon to cover their losses.

The Obama Administration’s announcement shouldn’t surprise anyone at this point. We have been consistently mislead by Obamacare’s promises. During the 2008 election, then-presidential candidate Barack Obama boasted his healthcare plan would reduce annual premiums by $2,500 for a typical family. Instead, premiums for the average family rose $708 in Wyoming according to the Heritage Foundation.

Then, as Obama was pushing his healthcare law through Congress, he reassured voters “If you like your healthcare plan, you will be able to keep your healthcare plan, period.” Wrong again. 4.7 million patients saw their plans cancelled because they were in violation of Obamacare’s onerous regulations.

Obamacare’s broken promises holds important lessons for Wyoming’s legislators in 2016. Governor Mead recently announced he will try yet again to expand Medicaid, claiming the federal government will pay 90 cents on the dollar for the program. Senator Charlie Scott warned his colleagues during last year’s legislative session of the perils of trusting the federal government:

“You know the federal government is going to back off of its promise to pay 90 percent. You know that because when you look at their finances, they’re in bad trouble across the United States.”

If the federal government can’t manage a meager $3 billion insurer bailout fund, why should we trust it to fully fund the $500 billion Medicaid program? Patients, insurers, and taxpayers have been misled at every turn under Obamacare. Our legislators must stand firm and again reject Medicaid expansion in Wyoming.

In a moment of bipartisan wisdom, the Labor, Health, and Social Services Committee sponsored legislation allowing out-of-state nurses to practice in Wyoming. Like many states, Wyoming bars nurses not licensed by our nursing board to practice here. The status quo restricts the supply of nurses, preventing patients from accessing thousands of qualified nurses, not to mention raising healthcare costs. The committee’s members took a decisive step towards expanding healthcare access in the state of Wyoming.

The issue was whether to join the Nurse Licensure Compact, or NLC, and the Advanced Practice Registered Nurse (APRN) Compact. The APRN Compact is an interstate agreement where the license issued by any member state is accepted by all. It would apply to Nurse Practitioners, Anesthesiologists, Clinical Specialists, and Midwives. These are nurses with postsecondary degrees who can examine, diagnose, and treat patients.

The NLC works the same for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). Since its inception in 1999, 25 states have joined this compact, freeing 1.4 million nurse to care for patients across state lines. In the words of Cynthia LaBonde, the head of Wyoming’s board of Nursing, “It’s like a driver’s license. It gives nurses the ability to cross state lines and practice nursing in any other state that is a party state.”

However, states outside of these compacts, including Wyoming, don’t recognize licenses issued by other states, even though every state has virtually the same requirements for nurses to practice. Every state requires nurses to have an Associate or Bachelors nursing degree, in addition to completing the National Council Licensure Examination; a test established by the National Council of the State Boards of Nursing. States also require every APRN to complete postsecondary education. Despite these uniform standards, Wyoming and many other states bar talented nurses from caring for their residents.

For these reasons, even Wyoming’s Board of Nursing favors joining these compacts and allowing non-Wyoming nurses to practice here. According to Cynthia Labonde, these nurses will provide crucial medical support for hospitals, especially during times of emergencies.

She’s right. Wyoming is in desperate need of more healthcare professionals. According to the federal Department of Health and Human Services, a quarter of Wyoming’s population live in communities designated as Health Professional Shortage Areas. There are currently only 191 doctors for every 100,000 residents, compared to the national average of 260. Opening Wyoming’s borders to more nurses will not only help physicians care for their patients, but allow more APRNs to start their own independent practices as well.

In addition, advanced nursing care is far less expensive than physician care. The average salary for an APRN in Wyoming is $90,400, less than half of what physicians make, according to the Bureau of Labor Statistics. Utilizing more nurses will make our healthcare more accessible and more affordable.

But these compacts’ greatest contribution will be allowing future medical innovations to flourish. Using the latest information technologies, providers are finding new ways to care for patients remotely through Telemedicine. They can consult patients, diagnose diseases, deliver treatments, and monitor conditions without ever meeting in person.

Right now it’s illegal for nurses in other states to even consult with Wyoming patients by phone or video. By joining the APRN Compact, Wyoming patients will be able to access advanced nurses across the nation electronically for their healthcare needs. Senator Charlie Scott was particularly interested in this prospect. He said “They’ll be able to practice just like if they had a Wyoming license.”

Allowing out-of-state nurses to practice in Wyoming is a critical reform for better and cheaper medical care. Both Republicans and Democrats on Labor, Health, and Social Services Committee realize this. Let’s hope the rest of the Wyoming Legislature does as well.

Since Obamacare took effect in 2013, the cost of health insurance has exploded. Turns out it’s very costly for the insurers themselves and some are paying the ultimate price.

In early October, one of those insurers, WINhealth, announced it faced severe financial challenges and was leaving the Obamacare exchange. Just 11 days later, the company declared bankruptcy, leaving 13,000 Wyoming customers uninsured.

In its press release, WINhealth blamed Obamacare’s bailout program, known as the Risk Corridor, for shorting its promised subsidy. The Risk Corridor is a federal slush-fund established to subsidize less profitable insurance carriers with funds taken from more profitable ones. Unsurprisingly, not many insurers are making money under Obamacare. The subsidy program could only pay 12 percent of what it promised, forcing several insurers, including WINhealth, to shut down.

Obamacare’s backers naively blame WINhealth’s failure on Republicans in Congress. Kerry Drake wrote in WYofile that Republicans deliberately weakened the program by preventing Democrats from bailing it out with taxpayer dollars.

They made the right call.

Congressional Republican knew Obamacare would impose crippling costs on insurers and didn’t want taxpayers on the hook for them. Thanks to their efforts, the federal government’s 2014 budget barred the Risk Corridor from taking taxpayer dollars when it fell short. Obamacare was already set to add trillions to the federal debt, and Republicans didn’t want to add a penny more.

What Kerry Drake and other Obamacare supporters don’t realize is that Obamacare will fail, no matter how much money the federal government spends. Its architects hoped that millions of healthy individuals would sign up to make the math work. Before it became law, the federal government promised 15 million individuals would enroll during Obamacare’s 2016 insurance enrollment period, from November 1, 2015 to January 31, 2016. Even the Obama administration now admits that figure is unrealistic and now estimates just 900,000 new customers will sign up.

After Obamacare drove up premiums and deductibles, it simply doesn’t make any sense for healthy people to buy insurance. According to the US Census, the average 18-34 year old spends just $600 a year on medical care. But the least expensive Bronze plan on the federal exchange in Wyoming costs $3,672 in premiums and has a $5,500 deductible. Does that sound like a good deal to you?

It only makes sense to buy such expensive insurance if you are extremely sick and require costly treatment. WINhealth was hemorrhaging cash paying claims for sick customers and didn’t have enough healthy ones to pay for them. Wyoming’s Department of Insurance revealed in a press release that the insurer burned through $5.3 million in savings to pay claims.

Without healthy people enrolling, insurers have to raise premiums or risk going out of business. Last year, premiums increased a whopping 53 percent in Wyoming. But even that wasn’t enough to save WINhealth. Wyoming’s remaining insurers, both on and off the exchange, now plan to raise premiums another ten percent in 2016.

Despite enormous premium increases, insurers are losing money hand over fist selling Obamacare coverage. After analyzing insurance claims, analysts at Mckinsey found that insurers lost $2.5 billion selling insurers on Obamacare exchanges.

For a health insurer to stay in business, it needs enough healthy individuals paying premiums so it can pay the medical bills of its sicker customers. But under Obamacare, only the sickest and most expensive patients are signing up for insurance.

No matter how its supporters try to spin it, Obamacare has been a disaster for everyone. Taking more money from taxpayers wouldn’t have saved WINhealth, and certainly wouldn’t make healthcare more affordable.

Medicaid’s allies are gearing up their expansion drive for the 2016 budget session. As usual, they’re trying to convince Wyomingites that they will save big if government spends more of their money. We’ve heard this story before.

Governor Mead, Wyoming’s Hospital Association and the Department of Health all claim that Wyoming’s uninsured population is freeriding on our healthcare system by using services without paying for them. If only we expanded Medicaid and enrolled them in a government insurance program, taxpayers and hospitals alike will save money. According to Saint John’s Medical Center in Jackson, WY:

“If the Legislature accepts the Governor’s plan and expands Medicaid, hospitals across Wyoming will gain many patients who can pay more of their costs. Our hospitals will thus be in stronger position to keep serving their communities.”

Wyoming’s elected leaders should reject these false promises.

Expanding Medicaid to stop uncompensated care is wrong for three reasons:

1) Medicaid is a leading cause of uncompensated care.

In Wyoming, Medicaid reimburses hospitals just 84 cents for every dollar of service they render to patients. Medicaid and Medicare combined account for half of all the care Wyoming’s hospitals provide that isn’t fully paid for.

In states that expanded Medicaid, uncompensated care hasn’t fallen as promised. According to Moody’s Investors Services, hospitals in states that expanded Medicaid are no more profitable than ones in states that rejected expansion. After Illinois expanded Medicaid in 2013, Southern Illinois Healthcare lost $14 million caring for Medicaid’s new patients.

2) Expanding Medicaid will increase uncompensated care.

Patients that would be covered by Medicaid Expansion are already eligible for generous premium tax credits and other subsidies to buy private insurance. They can go on Obamacare’s insurance exchange and purchase coverage for only $38 in monthly premiums and a $150 deductible, for a total annual cost of $606. That’s about half of the cost of the average cell phone bill.

Under Medicaid Expansion, these individuals will lose their private insurance and must enroll in Medicaid for their health insurance. As more individuals use Medicaid, the program will underpay for even more services. Hospitals will rack up even more uncompensated care and taxpayers will be left with the tab.

(3) The Medicaid Expansion “solution” will cost more than the uncompensated care problem.

Every year, Wyoming taxpayers compensate hospitals $41 million through property taxes for their uncompensated care. This costs the average Wyoming family $180 every year in taxes. But according to the Congressional Budget Office, the federal government will spend $931 billion on Medicaid Expansion by 2022. This would cost every family $839 more in annual federal taxes and interest on our debt.

Contrary to Medicaid Expansion’s proponents, rejecting Medicaid Expansion is actually saving taxpayers money. Since Wyoming and 19 other states refused to expand Medicaid, $392 billion won’t be spent by Washington on this government entitlement. This will save the average family $3,181 in taxes over the next eight years.

Despite what Governor Mead and interest groups say, money from Washington DC is never free. We all have to pay for it through our federal tax burden, the attached strings and any inefficiency taking federal money creates. Wyoming’s legislators should keep that in mind as they contemplate expanding Medicaid in 2016’s budget session.

Obamacare’s supporters seem to believe that if you give patients insurance, doctors will treat them. But greater access to health insurance doesn’t mean greater access to healthcare. As patients scour Obamacare’s insurance exchange for coverage, they’re finding fewer doctors accepting Obamacare’s insurance as payment. And those that can are spending less time with patients, possibly compromising their care.

Doctors often reject Obamacare patients because of expensive new regulations the law imposes on insurers. Insurers must to cover an array of “Essential Health Benefits” for every policy holder. In addition, they required to charge everyone the same premium regardless of their health status. A study by McKinsey & Co. found that insurers lost $2.5 billion in 2013 because of Obamacare.

To cope with these costly mandates, insurers are cutting payments to doctors. To keep doctors on board, insurers promise them more patients in exchange for lower per-patient fees. How is this scheme working?

A survey by the physician staffing company, Locum Tennans, found that the biggest challenges doctors face under Obamacare are “increased patient visits with decreased reimbursement and increased paperwork, meaning less time with the patient.”

Welcome to socialized medicine.

Obamacare’s changes are steadily curtailing patient access to medical care. Many doctors would rather turn away Obamacare-insured patients than accept these low fees. A 2014 survey by the Medical Group Management Association, estimated as many as a quarter of practicing doctors are rejecting Obamacare insurance plans for pay.

Alan Miller, CEO of the hospital group Universal Health Services, which owns the Wyoming Behavioral Institute in Casper, has also noticed doctors opting out of Obamacare because of lower insurance reimbursements. On CNBC, he said:

“They get a better reimbursement when they take care of people that have insurance through their employer. The doctors get reluctant to schedule appointments [with patients who have Obamacare].”

This doctor shortage is only going to get worse as more physicians hang up their lab coats over the next several years. According to the Association of American Medical Colleges, one third of practicing physicians are over the age of 55 and plan to retire by 2020.

Marivern Eastern, assistant director of the University of Wyoming’s College of Health Sciences, said in UW’s August newsletter that Wyoming will be hit particularly hard by the paucity of providers. “Wyoming is facing a critical shortage of healthcare workers. The shortage will worsen as the baby boomer generation ages.”

The doctors that remain in Obamacare-provider networks will have less time than ever to care for new patients. The average US physician cares for 2,300 patients already, according to a survey in the Journal of General Internal Magazine. However, an article published in Annals of Family Medicine recommends patient panels no larger than 1000.

Doctors simply don’t have enough time to care for so many patients. A doctor with 2,500 patients would theoretically have to work 21.7 hours every day for a year to provide all of their recommended acute, chronic, and preventive care, according to the same article in Annals of Family Medicine.

Physicians require ample time to properly diagnose and treat their patients. When they take on too many patients, their time is limited, and patient care suffers. Physicians on average spend just 15 minutes with every patient. As a result, patients receive only half of their recommended chronic and preventive care.

Obamacare’s cheerleaders measure the law’s success by how many patients it covers. Sadly, few if any doctors can afford to treat individuals with Obamacare insurance. And the ones that can are spending less time with patients.

Supporters of Medicaid Expansion, including Governor Matt Mead, express an unwavering belief that the federal government will actually fund this entitlement as promised. Yet Washington’s promises often become unfunded mandates. Even before the end of this year it is likely that Congress will cut federal funding for Medicaid Expansion and leave states holding the bag.

If Wyoming expands Medicaid, the federal government promises to cover 100 percent of its costs in 2016, and then 90% of its costs afterwards. But considering our growing national debt and unfunded liabilities, where would this money come from? Obamacare’s faithful supporters nevertheless stand by Washington’s pledge, undeterred.

Governor Matt Mead reiterated his faith in the federal government by calling on Wyoming’s legislators to expand Medicaid in his 2017/2018 biennium budget proposal. He said:

The federal participation in optional Medicaid expansion is estimated to result in more than $268 million in additional federal funds flowing to Wyoming. These dollars would be spent on hospitals, doctors, nursing homes, mental health centers and other providers located in communities across the state.

On being asked whether the federal government will actually fulfill its obligation, Mead said, “These are questions without clear answers.”

One place to look for clarification is in history.

In 2009, President Obama’s administration asked states to borrow through federally-subsidized Build America Bonds. Washington wanted states to spend more money on infrastructure projects, and these bonds offered lower interest rates than tax-exempt state bonds. States took Washington at its word, and borrowed $181 billion in these bonds.

Then in 2011, President Obama signed the Budget Control Act, cutting federal spending by $1.2 trillion over ten years, including billions owed to states under the Build America program. When these cuts went into effect in 2013, the US treasury reduced its bond subsidies by 8.7 percent, costing Wyoming over $12 million.

Even programs intended to educate children were cut by the federal government. The Budget Control Act also arbitrarily reduced education aid to Wyoming’s low income and disabled children across nineteen federal programs by $6.8 million.

As for Medicaid expansion, then prominent member of the House of Representatives Paul Ryan indicated in 2013 that Washington wouldn’t be holding up its end of the bargain for long. He issued a stark warning to all fifty states:

The fastest thing that’s going to go when we’re cutting spending in Washington is a 100 or 90 percent match rate for Medicaid. There’s no way. It doesn’t matter if Republicans are running Congress or Democrats are running Congress. There’s no way we’re going to keep those match rates like that.

Now Speaker Ryan is setting the agenda for half of Congress. Before the end of the year, he’s expected to have the House vote to repeal vast swathes of Obamacare, including federal funding for Medicaid Expansion.

What is clear is that Wyoming’s leaders should not be making another dubious deal with Washington that expands Medicaid.

The director of Wyoming’s Department of Health, Tom Forslund, recently sat down before the Joint Appropriations Committee (JAC) to make his plea for more spending. The biggest item by far on the agency’s wish list was Medicaid Expansion, costing a whopping $268 million. How did he try selling such an expensive line item to the JAC? He claimed Medicaid Expansion would actually save Wyoming money.

The notion that taxpayers will save money while government programs grow is certainly attractive to beneficiaries of government largesse. Vickie Diamond, President and CEO of the Wyoming Medical Center, echoed this fallacy in the Casper Star Tribune, saying Medicaid Expansion would:

“significantly reduce our $200 million budget shortfall. This funding frees up state dollars currently being spent on programs for the uninsured, allowing the governor and the Legislature to redirect funds to other important areas like building roads and investing in our schools.”

While this claim is indeed appealing, it is complete fiction.

Should legislators expand Medicaid, the government’s burden on taxpayers will still go up. The Health Department is expected to spend $1.92 billion in the current biennium. But for the next biennium, the department wants $355 million in new spending, bringing their total budget request to $2.29 billion. What this government agency really means by “savings” is that Medicaid Expansion would help pay for the new spending it wants.

One of the Health Department’s biggest budget requests is $11.3 million in new spending on Title 25, i.e. emergency detentions and involuntary hospitalizations. Under Title 25, Wyoming’s 23 counties have the authority to detain mentally unstable individuals suspected of being a threat to themselves or others. Once an individual is identified as a threat, they are transferred to a hospital for involuntary treatment. Counties pay for the first 72 hours of detention and treatment. And the Department of Health is on the hook for all other costs going forward.

But even by the Health Department’s questionable definition of “savings,” Medicaid Expansion won’t cover the cost of the agency’s spending increases. It turns out that under its rules, Medicaid cannot pay for involuntary treatments. So even if Wyoming expanded the program, the state and counties would still have to pay millions to treat mentally ill individuals under Title 25.

Members of the Appropriations Committee quickly realized these purported savings were imaginary. Upon hearing that Medicaid Expansion wouldn’t actually displace Title 25 spending, Senator Bruce Burns (R-Sheridan) asked Director Forslund:

“Am I missing something here? How would Medicaid Expansion care for them if [Medicaid] can’t pay for involuntary hospitalization?”

Forslund admitted:

“We can help [the mentally unstable] before they reach crisis situations. Medicaid Expansion, by itself, will not solve the problem of Title 25.”

It turns out that Forslund’s grand money-saving scheme is to expand Medicaid and hope it reduces the number of individuals admitted into hospitals through Title 25.

The Department of Health’s assumption that Medicaid Expansion would reduce future involuntary treatments is without foundation. According to agency officials, the department has no idea whether individuals being hospitalized through Title 25 would even qualify for expanded Medicaid. It’s likely that many Title 25 individuals will either make too much money, or belong to a household that makes too much money to qualify for Medicaid Expansion.

And even if an individual qualifies, they would still have to enroll. People hospitalized through Title 25 usually end up there because they lack the family and community resources that are essential to treating mental health. Without support from their families and communities, many mentally ill individuals are more likely to forego treatment than to seek it out for themselves.

A survey by the Employment Benefit Research Institute found that mentally ill individuals seek far fewer mental health treatments when they live by themselves than if they are a dependent. Merely expanding a faceless government program won’t help mentally disabled individuals if they lack social support to guide them through the enrollment and treatment process.

There are far more humane and cost-effective ways to treat the mentally disabled. The Title 25 Subcommittee recently proposed a series of reforms that would make mental healthcare more patient-centered and less invasive. And none of these proposals include signing vulnerable individuals onto a federal program that’s hurtling towards bankruptcy.

After hearing the Health Department’s testimony, it became clear to listeners that Medicaid Expansion won’t relieve Wyoming’s fiscal crisis. Taxpayers will still be on the hook for another ballooning government budget.